Unilateral biportal endoscopic discectomy combined with annulus fibrosus suturing for lumbar disc herniation: a retrospective study of early clinical and radiological outcomes.

OBJECTIVE: To evaluate the clinical efficacy and radiological outcomes of unilateral biportal endoscopic (UBE) discectomy combined with annulus fibrosus suturing compared with UBE discectomy alone in the treatment of lumbar disc herniation (LDH).

METHODS: A total of 62 LDH patients with LDH who underwent UBE surgery at the Affiliated Hospital of Jiangsu University between February and June 2024 were enrolled. Patients were divided into two groups: the discectomy with annulus suture group (Suture Group, n = 30) and the discectomy-alone group (Discectomy Group, n = 32). General patient data, operative time, time to first ambulation, and hospital stay were recorded. The Visual Analog Scale (VAS) was used to evaluate pain in the lower back and legs, while the Oswestry Disability Index (ODI) assessed functional status, both preoperatively and at multiple postoperative follow-up visits. Intervertebral disc height and Pfirrmann grade were evaluated preoperatively and at 1 year postoperatively to assess degenerative changes. Recurrence rates at 1 year and clinical outcomes (modified MacNab criteria) were analyzed.

RESULTS: All operations were completed successfully, and all patients were followed up for more than 1 year. There were no statistically significant differences between the two groups in postoperative ambulation time or length of hospital stay (P > 0.05). However, the operative time was significantly longer in the Suture Group than in the Discectomy Group (P < 0.05). At all postoperative time points, both the VAS scores for low back and leg pain and the ODI were significantly improved compared with preoperative values in both groups (P < 0.05). The leg pain VAS score at 3 days postoperatively was significantly lower in the Suture Group than in the Discectomy Group, whereas no statistically significant between-group differences (P > 0.05). At the final follow-up, the intervertebral disc height at the operated level decreased by 8.98% compared with the preoperative value in the annular Suture Group and by 10.09% in the Discectomy Group, with no statistically significant difference between the two groups (P > 0.05). Progression of disc degeneration was observed in two patients in the Discectomy Group at the final follow-up, whereas no aggravation of disc degeneration was noted in the Suture Group. Two cases of same-level postoperative recurrence occurred in the Discectomy Group, corresponding to a recurrence rate of 6.25%, whereas no recurrence was observed in the Suture Group. According to the modified MacNab criteria at the final follow-up, there was no statistically significant difference in the excellent-to-good rate between the two groups (P > 0.05). In the Suture Group, two patients experienced transient aggravation of postoperative lower extremity numbness, which improved before discharge after conservative treatment including dehydration therapy and corticosteroids.

CONCLUSION: In selected patients with single-level lower lumbar paracentral LDH, both UBE discectomy alone and UBE combined with annular suturing provided favorable short-term outcomes.